Last week, a federal district judge in Texas who has not seen a part of the ACA that he thinks is legal, ruled that a significant chunk of the preventive care mandates in the law are either illegal or unconstitutional. The suit was brought by a religiously owned company that does not want to pay for mandated PrEP for AIDS/HIV prevention medication.
Judge O’Connor just held that *key parts* of the ACA’s preventive services requirement are unconstitutional. He upheld the requirements for kids, vaccines, and women (for now) but not those recommended by US Preventive Services Task Force.
Decision here: https://t.co/VvzBbe03AT pic.twitter.com/YlbDpozLGM
— Katie Keith (@Katie_Keith) September 7, 2022
In the short run it is going to get appealed and likely go to the Supreme Court in a year or two.
Insurers are mandated to provide preventive care services because the business case for high value preventive care services is not particularly good from the payer of those services even as they can produce long term societal value. Most preventive care services are not immediately cost saving. There are costs to provide a service, and then, especially for screening services, there are costs of treatment of newly discovered problems. These treatments may produce great value but most of that value is either accruing to the patient or to reduced future medical expenditures. Some vaccines are likely cost saving within a contract year but other than that, it is hard to see cost-savings that an insurer can immediately internalize.
I have a working paper currently under review that looks at the take-up of some of the common preventive care services that are mandated to be cost free. I can’t say much but a common thread in this ongoing work and that of many other researchers is that there are multiple barriers and facilitators to care. Reducing cost to zero is helpful to increase take-up but it is not the only thing that keeps people from getting recommended services.
If this ruling stands or mostly stands without a Congressional update, then insurers will have very strong business cases to impose cost-sharing on almost every preventive service except perhaps flu shots which means screening and prevention will be less common in the future.
Ruckus
Aww the wonderfulness of I’ve got mine, fuck you thinking.
David, is there any estimation on how many human beings conservative bullshit kills every year with stuff like this?
Dorothy A. Winsor
Someone’s religion requires they let people get AIDS? I assume they’re trying to monitor gay relationships. That’s obviously bad. How do they feel about straight people who get it? Or babies who get it from an infected mother?
These people, and that judge, are loathesome
Another Scott
“I refuse to pay the federal gasoline tax because it violates my sincerely held religious beliefs that …”
“I refuse to obey the Mann Act because it violates my sincerely held religious beliefs that …”
It all comes down to “you can’t tell me what to do”, via whatever excuse they can find that the SCOTUS will accept (and they’ll accept anything to beat down the modern structure of the federal government).
Grr…
Thanks for fighting the good fight.
Cheers,
Scott.
Ohio Mom
I’m reminded of Pelosis’s comment about the ACA, “We won’t know what’s in it until we pass it.”
Conservatives took that statement to mean that she was selling us a pig in poke, how gullible does she think we are, why should we spend money not knowing what we will get, we are being robbed!
But I took it to mean that many benefits will flow from the ACA that we can not yet see. I read somewhere the other day of a study that showed crime went down when communities became healthier (sorry I don’t remember where I read that). That is the sort of thing that passing the ACA would let us know.
Certainly preventing HIV would be another but we would only know that in the aggregate and in hindsight.
Of course if the ACA keeps being chipped away, those yet-to-be-discovered benefits will never materialize. The right-wing version, that the ACA would accomplish nothing except spending money, would never be realized. They know what they are doing.
Anonymous At Work
I think that SCOTUS will be hard-pressed to uphold O’Connor’s rulings. He’s giving them a bad name as is, will raise the cost of healthcare considerably in a way directly linked to SCOTUS’s ruling and increases the chances of KBJFI #1-6 being added to SCOTUS.
KBJFI = Ketanji Brown-Jackson’s Favored Intern, as in, very young and looking at 40-60 years on court.
Nicole
Ugh. Cost sharing.
I injured both my corneas two weeks ago- long story, but the end result was I abraded 80% of the top layer of both of them. We have excellent health insurance, and SUNY College of Optometry, where I go for my eye care, took very good care of me- a doctor saw me as soon as the urgent care floor opened and they continued to see me every day for a full week to make sure everything was healing properly (minus Sunday, ’cause office closed). And there was a $40 co-pay for each visit, which added up to $240 for that first week. Which we could handle, but for a lot of people, it’d be a genuine hardship. And it’s a person’s vision, which is a big deal.
So yeah, not cool when insurance companies get even more opportunities to pass the cost of care onto the consumer, especially for preventative services.
(Eyes have healed well; now it’s just arguing with the insurance over why they don’t feel medication for my chronic dry eye is medically necessary. I guess maybe I needed to abrade off 90% before they would feel it was serious? Rolling my eyes with their freshly regrown corneal layers.)
CaseyL
it’s vital to remember the purpose of the Federalist Society is not to uphold the law in any way, shape, or form. Even in a distorted way, shape or form.
The purpose of the Federalist Society is to undermine, undo, and wreck the very concept of law: to reduce it to whatever their patrons want, in any given case, regardless of facts or precedents.
To make “Wilhoit’s Law” the actual governing philosophy for the whole country.
Don’t look for consistency, or logic, or anything like that.
Sister Golden Bear
@Dorothy A. Winsor: The plaintiff explicitly opposed PReP because it “encouraged homosexual behavior.” So yeah.
Quantumman
They will use this case as the opportunity to get rid of the ACA in total. The Federalist group and other conservatives will be salivating over this chance to declare the whole thing unconstitutional.
Villago Delenda Est
1. Judge O’Connor is a dickhead
2. Long term benefits don’t help the current fiscal quarter for the providers or the insurers.
3. The good for all of society by preventing disasters before they happen doesn’t buy new boats for providers and insurers.
Villago Delenda Est
@CaseyL: They’re neo-feudalists. They hate the Enlightenment, and all its fruits, to include the Constitution of the United States.
Omnes Omnibus
There are and always be judges who make bad decisions.
WaterGirl
@Omnes Omnibus:
Agreed. Except that now that blatantly political judicial decisions have been modeled by the Supreme Court justices, it seems that it’s like climate change, not only are there are more bad decisions (climate events) but the ones there are tend to be even worse.
Ohio Mom
@Nicole: I also have very dry eyes, in part as a result of RA. My opthamologist is a cornea specialist who jokes about how small her speciality is — mere millimeters.
I can vouch for how effective the dry eye drops are. I use Xxidra but there is at least one other brand; all are horribly expensive because they are still under patent, no generics yet.
One pro tip/hack is that you can usually get four doses out of one tube if you store the open tube carefully. After putting a drop in each eye I put the open tube, opening up, in a little plastic cup. Then when it’s time for the next set of drops, the open tube is ready to go.
Sometimes I even get five sets of doses out of one tube, which horrifies the opthamologist because there are no preservatives in the drops. So pretend you didn’t just hear that.
sdhays
@Dorothy A. Winsor: I find it perplexing that the Hobby Lobby decision, or this one, wouldn’t allow me to not pay for my employees’ cancer treatments because my magic sky monster told me that that’s how He marks and punishes sinners.
wenchacha
@Sister Golden Bear: I guess Viagra does that, too. For men, anyhoo.
Ruckus
@Dorothy A. Winsor:
“These people, and that judge, are loathesome”
You my dear, are way, way too nice. Loathsome? They’d have to improve around a million % just to be at loathsome.
Ruckus
@Ohio Mom:
I often have dry eyes and use OTC eye drops when necessary. The best thing I’ve found is the night time drops. They keep my eyes moist the entire night so I don’t wake up feeling like I lost a sheet of 100 grit sandpaper in my eye sockets.
WhatsMyNym
My question is who is forcing them to buy insurance for their employees’
ETA: there are alternatives for the employer, so No Standing.
Dan B
My partner and I lost dozens of friends to AIDS. Some friends, more gregarious, lost hundreds. This ruling brings back the horror of that time. Will this ruling force people to pay full price for MPX (Monkeypox) vaccines? Will MPX spread far beyond the MSM community? Will calls to quarantine MSM be revived? How many people will suffer? You don’t have to have sex to get sick. What happens if it becomes endemic? What do we do then?
Will judges recognize that nature doesn’t care about laws and morality based upon the lust for punishing people into “proper” behavior?
Ohio Mom
@Ruckus: You mean the OTC gel drops, yeah, sometimes I use those at night in addition to the prescription drops. Also use the non-gel OTC ones during the day on occasion, and OTC Zaditor during allergy season. Depends on how dry my eyes are, they fluctuate. Sometimes hot compresses too — my eyes are DRY.
Redshift
@Ohio Mom:
That’s actually the right-wing distortion of her comment, which they made up to pretend that lawmakers didn’t know what they were voting for. Her actual comment was “You won’t know what’s in it until we pass it,” which is to say, the public should believe what they actually get, not what public liars are telling you is in it before the text is final.
Gunga Dean
Cruelty is the point with these assholes.
Ted Doolittle
Adding to the lack of a payer-side business case for preventive care: yes in some cases preventive care may detect disease conditions and prevent them from deteriorating. But there are at least two countervailing forces: 1. some folks w/ undetected disease conditions will die quickly — and cheaply — from the undetected condition, while those whose diseases are caught early may need lengthy — and expensive — treatment; 2. if preventive services extend lifespan, then the saved person will incur medical expenses throughout the extended life — and then many years later will contract and die from another condition, perhaps very expensive.
So the case for preventive care is a public health & individual wellness argument: that it can increase health & well-being and adds years to life. It is not an economic or a money-saver case, and this is true not just from the payer perspective, but from the whole-system, whole life-cycle, national health expenditure perspective.
Preventive care is a win, but not a win-win
Which is why it must be mandated.